Evaluation of the Effect of Plasma Occlusion of Punctum (POP) on Dry Eye Disease Treatment: A 6-month Randomized Clinical Trial

Background: The effect of punctum stricture with atmospheric low-temperature plasma has been evaluated in a 6-month randomized clinical study for dry eye disease (DED) treatment. Methods: This study included a total of 60 patients with moderate to severe dry eye disease, with the comorbidity of rheumatologic disorders. The control group (CG) with 30 participants continued to receive their previous medical dry eye treatment, and the test group (TG) including 30 patients were treated with plasma occlusion of punctum (POP), as well as their same medical cures. POP method was performed by a surgeon using the PLEXR Plus device over three sessions with a one-week interval. The outcome of this method was proved by visual parameters, OSDI questionnaire, dry eye tests and punctum size measurements. Results: As we expected, no specific changes were observed in the uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and intraocular pressure of all patients in both groups of this study. Tear meniscus height (TMH), tear break-up time (TBUT) and schirmer tests indicated a significant increase of 79.8%, 69.99% and 86.20%, respectively, in all patients in test group with POP intervention. Additionally, in the TG, Optical coherence tomography (OCT) and slit-lamp examination showed a meaningful reduction in outer punctal diameter, punctal depth, and horizontal inner punctal depth six months after POP procedure (*p-value<0.05). Conclusion: It seems that POP procedure with transient stricture of punctum size can be a safe, effective, office-based and low-cost treatment for moderate to severe grade of dry eye disease which is the most prevalent eye disease all over the world.